I’m gonna need some aquavit first.
That’s beautiful. It is also the perfect response to the “socialized medicine” position of the right.
What’s bizarre about this [the OP] is that Barry “friend of banks” Obama, whose strongest criticism from the left is his indifference to working-class people & support of predatory lenders, is being somehow blamed for redistributive policies established twenty years before he was born & generally embraced by society.
:rolleyes:
All out. How about some Kool-Aid?
Lutefisk I can avoid, but I’d be afraid to sit down in their crappy chairs.
Only if it’s lingonberry flavored.
Yes, it makes it all better–no more booboos for me!
General thoughts:
So, shitty service (the 30%) is ok? 
There is no reason for that kind of delay–unless it’s because said insurance co refuses to pay for more workers or upgrade systems because that would cost them something. I have a friend who is an insurance agent: home, car, life (not health care that I know of). Every year he gets some award for most or best something–new clients, accounts, most denied claims for all I know. Here’s the thing: I’m all for recognition. But-- his “award” ceremonies tend to occur in Hawaii, the Dominican Republic, Florida, Jamaica etc over long weekends or week long events. This is no banquet downtown with boring speeches after. And it’s all FREE to him and his wife. Gee–I wonder where my premium is going and why it’s so high?
:rolleyes:
Answer me this: do those who deny claims have ANY medical background at all? RN, MD, classes on chronic diseases, chronic pain, disabilities, developmental delays, risks associated with no prenatal care, risks associated with alcohol/drug dependency etc? I’m betting not.
Just had a pt today who is 81 and had outpt hernia surgery. She lives alone–no family. She’s spry and ok, but 81 and frail. Doc wants a home health nurse to go out for just one visit, just to check on her-- a good idea, we all agree. Medicare won’t pay for it (yes, it’s the Gment this time–tell me a private insurance company will pay for this–I highly doubt it). This is POOR CARE forced on the HC industry by insurance. What if the Vicodin makes her dizzy or groggy and she falls? Or the Vicodin makes her constipated and she ends up rupturing when straining at stool? Or she starts vomiting and gets dehydrated? Big, expensive hospitalization happens, that’s what. But a short visit from a HHN would address these issues, make sure she’s eating right etc–much less expensive, but won’t happen.
American health care, as managed by insurance companies sucks. I hope Obama does demand transparency and stuff like this becomes common knowledge. As the Boomers age, they will not put up with this–and using crisis approach health care for the massive Boomer pop will bankrupt us.
[/soapbox]
Half the bankruptcies in America are due to health problems. How can that be OK. You lose everything and are still sick. Not very enlightened.
But if those folks would just find their bootstraps and pull themselves up and stop whining, they’d be true Americans. America is not kind to the weak, really. 
Well, that’s what he gets for not being a Republican. Before he got into politics he should’ve done the research.
It is OK because the Invisible Hand says it’s OK. Those bankruptcies are nicely balanced out by all the stockholders of the private insurance companies who are getting richer.
Those rich stockholders then use that wealth to create jobs (trickle, trickle). So, that middle-class retail manager or factory worker who went bankrupt trying to pay his bloated hospital bills can rest easy knowing that one more minimum-wage McJob is ready and waiting for some other retail manager or factory worker who just got laid-off.
And since NO health insurance comes with that new McJob, this also creates an excellent opportunity to either force that McWorker to pay way more than he can afford for some lame catastrophic health insurance, OR, force HIM into bankruptcy too.
Or whatever. I’m so sick of the “profit at all cost” bullshit that I can’t even think or write straight. Sorry.
Are you sure you’re not a Republican? 
RID, Republican in Denial. Lot of that going around.
It depends. Most claims that are denied are not denied by people at all. about 92% of our claims are processed automatically by the computer system with no intervention at all.
If a customer claims it is wrong, medical information usually does not come into play. What we are looking at is, did we pay this correctly according to the plan your employer chose? Most of the times the issue is pretty straightforward. If your plan says we pay 100% on an annual colonoscopy, it is pretty straightforward.
There are some claims that are reviewed by people with medical training. This happens alot with any type of rehabilitation therapy (physical, occupational, cardiac, speech, chiropractic) as it is not as cut and dried, and there is a wide variety of coverage depending on what the employer chose. Many employers limit the # of visits, or a treatment plan may be needed. Many employers will insert the language that the rehab plans have to be designed to actually improve functioning and not just maintain it, and within a certain amount of time.
It also may get reviewed if the provider is giving an unproven treatment, or a type of service associated with high rates of fraud.
Also, any kind of transplants, or cancer issues, get handled by special teams with additional training.
oh yes and as far as pregnancy we do have a team setup for that as well, and we also have folks specially trained to deal with the alcohol/drugs issues.
ummm… you’re kidding, right? Or did my thinking and writing get so out of control that I don’t even know what I wrote??
Hey, just bustin’ yer chops a little…
Is that right? Do you have a cite? If it is, my guess is that people plan poorly. They put buying a home ahead of having adequate health insurance, including long-term disability. I have friends who were debating with me that we should have free health care because they want to buy a home and don’t wan to run into the problem you mention. Excuse me, but why should I pay your health insurance so you can buy a home. Save more until you can pay for both health insurance and a home. Or buy a smaller home. You know, decisions millions of people make and have made.
Are you saying that claims are denied without human review, even if superficial?
eleanorigby, my future son-in-law reviewed claims for an insurance company earlier this year. He was well qualified - political science degree and going to law school this fall. And I didn’t get the impression that they wanted to pay well enough to get people who really understood what they were reading about. They did have fairly complete guidelines and places to look things up, though.